When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Septic arthritis

View PDF
  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
最后审阅： 2 Dec 2025
最后更新： 17 Dec 2025

小结

定义

病史和体格检查

关键诊断因素

  • hot, swollen, tender, restricted joint
完整详情

其他诊断因素

  • history of intravenous drug use
  • history of diabetes
  • history of cutaneous lesions
  • prosthetic joint
  • history of rheumatoid arthritis or osteoarthritis
  • acute onset of symptoms
  • fever
  • low socioeconomic status
  • history of alcohol use disorder
  • history of previous corticosteroid injection
完整详情

危险因素

  • underlying joint disease
  • joint prostheses
  • immunosuppression
  • intravenous drug use
  • diabetes
  • alcohol use disorder
  • skin lesions
  • previous intra-articular corticosteroid injection
  • recent joint surgery
完整详情

诊断性检查

首要检查

  • synovial fluid Gram stain and culture
  • synovial fluid white cell count
  • blood culture
  • serum white cell count
  • erythrocyte sedimentation rate
  • CRP
  • plain radiograph
  • ultrasound
  • synovium biopsy for Mycobacterium tuberculosis
完整详情

需考虑的检查

  • synovial glucose, LDH, lactate, procalcitonin
  • synovial polymerase chain reaction (PCR)
  • serum procalcitonin
  • Neisseria gonorrhea culture and nucleic acid amplification testing
  • MRI
  • cardiac ultrasound
完整详情

治疗流程

初步治疗

prosthetic joint: suspected infection

native joint: suspected infection with negative Gram stain (or Gram stain not available)

native joint: suspected infection with Gram-positive stain and no risk factors for resistant microorganisms

native joint: suspected infection with Gram-positive stain and risk factors for resistant microorganisms

native joint: suspected infection with Gram-negative stain

急症处理

native joint: confirmed MSSA infection

native joint: confirmed MRSA infection

native joint: confirmed streptococcal infection

native joint: confirmed gram-negative rods infection

native joint: confirmed gonococcal or meningococcal infection

native joint: infection with fungi/tuberculosis/other organisms

撰稿人

作者

Blerta Green, MD

Fellow in Rheumatology

Section of Rheumatology, Allergy, and Immunology

Yale University School of Medicine

New Haven

CT

利益声明

RTS declares that he has no competing interests.

Robert T. Schoen, MD, MBA

Clinical Professor of Medicine

Section of Rheumatology, Allergy, and Immunology

Yale University School of Medicine

New Haven

CT

利益声明

RTS declares that he has no competing interests.

Francine Touzard Romo, MD

Associate Professor of Medicine

Division of Infectious Diseases

Warren Alpert Medical School

Brown University

Providence

Rhode Island

利益声明

FTR declares that she has no competing interests.

同行评议者

Andrew Keat, MBBS

Consultant Physician and Rheumatologist

Northwick Park Hospital

Harrow

UK

利益声明

AK declares that he has no competing interests.

Cheryl Main, MD, FRCPC

Medical Microbiologist

Infectious Disease Consultant

Hamilton Regional Laboratory Medicine Program

Hamilton Health Sciences

Hamilton

Canada

利益声明

CM declares that she has no competing interests.

John Ross, MD

Brigham and Women’s Hospital

Hospitalist Section

Boston

MA

利益声明

JR declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Ross JJ. Septic arthritis of native joints. Infect Dis Clin North Am. 2017 Jun;31(2):203-18. 摘要

Earwood JS, Walker TR, Sue GJC. Septic arthritis: diagnosis and treatment. Am Fam Physician. 2021 Dec 1;104(6):589-97.全文  摘要

Ravn C, Neyt J, Benito N, et al. Guideline for management of septic arthritis in native joints (SANJO). J Bone Jt Infect. 2023;8(1):29-37.全文  摘要

Benito N, Martínez-Pastor JC, Lora-Tamayo J, et al. Executive summary: guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT. Enferm Infecc Microbiol Clin (Engl Ed). 2024 Apr;42(4):208-14.全文  摘要

American College of Radiology. ACR appropriateness criteria: suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). 2022 [internet publication].全文

Mathews CJ, Coakley G; British Society for Rheumatology. Hot joint update 2017. Mar 2017 [internet publication].全文

Le Vavasseur B, Zeller V. Antibiotic therapy for prosthetic joint infections: an overview. Antibiotics (Basel). 2022 Apr 5;11(4):486.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • 鉴别诊断

    • Osteoarthritis
    • Psoriatic arthritis
    • Rheumatoid arthritis
    更多 鉴别诊断

  • 指南

    • Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)
    • Executive summary: guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT
    更多 指南

  • 患者教育信息

    Septic arthritis

    更多 患者教育信息

  • Videos

    Aspiration and injection of the knee: animated demonstration

    Aspiration and injection of the shoulder animated demonstration

    更多 操作视频
  • padlock-locked登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

内容使用需遵循免责声明